Obama’s Concessions

In previous posts, I have directed most of my ire about the failure to enact health insurance reform legislation at the democrats. After all, they have a commanding majority and should be held accountable for the failure to enact their legislative agenda. But it’s time to redress the imbalance and at least note that the republicans have consistently behaved irresponsibly and show no signs of any interest in accommodation.

Perhaps the republicans will be rewarded in the mid-term elections for their just say no obstructionism. If so, will the destruction of health insurance reform outweigh the long-term consequences of their inherent cynicism? I’m dubious. Throughout the process, the republicans have distorted or lied about what’s in the legislation, spent several months moving the goalposts during bipartisan negotiations, and have refused to put forth any coherent program for addressing the current system’s flaws.

Take cost controls for example. Have the republicans offered any policies designed to reduce costs over the long-term? If so, I’ve missed them. Each time the democrats offer to include cost controls, the republicans respond demagogically with characterizations of death panels and loss of Medicare benefits. It’s fair to conclude that republicans favor implicit rationing through insurance coverage denials to explicit cost control strategies.

As a short-term strategy, republicans could regain control of Congress. Then what? Nothing in what’s transpired so far suggests that republicans have any reasonable approach to health care reform. For instance, I would have expected republicans to embrace health insurance exchanges, basically run by the private sector, as an aspect of sensible reform. Wrong.

Since we know that health insurance premiums will continue to escalate, that benefits will be reduced (for both private and public beneficiaries), and that needed delivery reforms will stagnate absent federal legislation, the republicans will confront the same angry mob they have so skillfully enabled and nurtured. At that point, though, their strategy will be exposed for its inherent their cynicism, which will impede any real ability to respond to what will inevitably be a major health care crisis.

Remember the republicans’ strategy during the Clinton health care debate? It was “let the market work.” Managed care will be the solution. Wrong—didn’t work. So here we are again, with republicans basically rejecting President Obama’s overtures to include republican ideas. Not coincidentally, Ramesh Ponnuru, writing in the 19 February National Review Online, extolled the conservative position as follows, after noting that conservatives favor the expansion of high-risk pools as a transition to a market-based health care system:

“They [conservatives] believe that if government allowed a robust market in individual insurance to develop, it would be easier for people to purchase cheap and renewable insurance policies before they got sick and the problem of ‘pre-existing conditions’ would therefore diminish over time.”

Talk about the triumph of hope over experience. This is a leap of faith that defies any rational relationship to addressing why the health care system is such a mess. It seems to me that the problem here is not that government impedes a robust market in individual insurance. Rather, it’s the individual health care insurance market that continues to fail. (OK—state mandates don’t help.) Thus, the conservative approach is to extend the market’s failure. If at first the market doesn’t work, then try it again. If it still doesn’t work, it must be the government’s fault.

Although the four ideas that Obama set forth are admittedly not a robust response to republican concerns, a responsible minority party would take the opportunity to negotiate ways to improve the ideas offered more to their liking. Predictably, the republicans have rejected them out of hand.

Frankly, I’m not much enamored with the ideas, either, and it’s hard to characterize them as concessions. Even though I don’t favor health courts or HSAs on policy grounds, their inclusion would be worthwhile if they could attract some republican support. Indeed, I would support some real concessions to expedite enactment.

Unfortunately, political cynicism now rules the republican party. Republicans are happy to talk about the costs of health reform. But they also need to address the high costs of inaction and offer cost controls that they find acceptable. The party of no ideas has spoken—irresponsibly.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.